Abstract

Introduction

The importance of preoperative chemotherapy in a multimodal management of patients with colorectal liver metastases (CRLM) has already been demonstrated. In this study, we analyse the relationship between CEA changes following neoadjuvant chemotherapy and disease free survival (DFS), post recurrence survival (PRS), and overall survival (OS) in patients with liver-only colorectal metastases who underwent liver resection.

Methods

The final cohort included 107 eligible patients. Increased CEA levels following neoadjuvant chemotherapy were defined as the increase of baseline CEA level (CEA level at diagnosis of CRLM) compared with the CEA level after completion of neoadjuvant chemotherapy. DFS, PRS, and OS were calculated using both Kaplan-Meier and multivariate Cox-regression methods.

Results

CEA increase was associated with decreased PRS and OS (HR 2.69; 95% CI, 1.28-5.63;p = 0.009, and HR 2.50; 95%CI, 1.12-5.56;p = 0.025 respectively) in multivariate analysis but there was no association between CEA changes and DFS. Sub-analysis demonstrated that in patients who did not receive adjuvant chemotherapy after the hepatectomy, CEA increase was associated with decreased DFS, PRS and OS (HR 2.74; 95%CI, 1.05-7.12;p = 0.038, HR 4.25; 95%CI, 1.16-15.61;p = 0.029, and HR 6.76; 95%CI, 1.61-28.42;p = 0.009 respectively). On the other hand, in patients who received adjuvant chemotherapy post-hepatectomy there was no association between CEA increase and DFS, PRS, and OS.

Conclusion

CEA increase following neoadjuvant chemotherapy is an independent adverse prognostic factor in patients who undergo liver resection for liver-only colorectal metastases. The association between increased CEA and DFS, PRS, and OS in patients who did not receive post-hepatectomy adjuvant chemotherapy may indicate that CEA increase following neoadjuvant chemotherapy could be considered as an indication for adjuvant chemotherapy in this group of patients. We suggest validation of this finding in an independent cohort and consideration of risk stratification for post-hepatectomy adjuvant follow up and therapy.